The association between temporal changes in the use of obstetrical intervention and small- for-gestational age live births

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dc.contributor.authorMetcalfe, Amy
dc.contributor.authorLisonkova, Sarka
dc.contributor.authorJoseph, KS
dc.date.accessioned2015-10-02T15:39:31Z
dc.date.available2015-10-02T15:39:31Z
dc.date.issued2015-09-29
dc.description.abstractBackground: The literature attributes secular declines in small-for-gestational age (SGA) live births to changes in maternal smoking and other maternal characteristics. However, there are reasons to believe that the observed reductions in SGA may be a consequence of early delivery following obstetric intervention. Methods: We examined temporal trends in obstetrical intervention and SGA among singleton live births in the United States from 1990 to 2010. The modified Kitagawa decomposition, based on the fetuses-at-risk approach, was used to assess the relative contribution of changes in the gestational age distribution and gestational age-specific SGA to overall changes in SGA. Reductions in SGA rates due to a left shift in the gestational age distribution were assumed to primarily reflect increased obstetrical intervention, whereas decreases in overall SGA due to decreases in gestational-age-specific SGA rates were assumed to reflect declines in risk factors. Results: Temporal trends in SGA followed a non-linear pattern, with substantial declines from 10.1 % in 1990–92 to 8.9 % in 2002–04, followed by a small increase to 9.1 % in 2008–10. Rates of maternal smoking steadily decreased throughout the same time period and changes in SGA rates were more consistent with changes in the gestational age distribution. The modified Kitagawa decomposition analysis also attributed the initial decline in SGA rates to changes in the gestational age distribution. Conclusions: Complex temporal pattern in SGA rates cannot be explained by the linear pattern of changes in factors like maternal smoking. Changes in the gestational age distribution are more consistent with the observed secular trends in SGA rates.en_US
dc.description.grantingagencyCanadian Institutes of Health Researchen_US
dc.description.refereedYesen_US
dc.description.sponsorshipCanadian Institutes of Health Research (MAH-115445).en_US
dc.identifier.citationMetcalfe A, Lisonkova S, Joseph KS. 2015. The association between temporal changes in the use of obstetrical interventions and small-for-gestational-age births. BMC Pregnancy and Childbirth 15:233 DOI: 10.1186/s12884-015-0670-5en_US
dc.identifier.doi10.1186/s12884-015-0670-5
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/33836
dc.identifier.grantnumberMAH-115445en_US
dc.identifier.urihttp://hdl.handle.net/1880/50995
dc.language.isoenen_US
dc.publisherBMCen_US
dc.publisher.departmentObstetrics and Gynecologyen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.institutionUniversity of Calgaryen_US
dc.rightsAttribution No Derivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nd/4.0/*
dc.subjectsmall for gestational ageen_US
dc.subjectcesarean sectionen_US
dc.subjectlabor inductionen_US
dc.subjecttime trendsen_US
dc.subjectpreterm birthen_US
dc.titleThe association between temporal changes in the use of obstetrical intervention and small- for-gestational age live birthsen_US
dc.typejournal article
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